Effectiveness and acceptability of non-pharmacological interventions to reduce wandering in dementia: a systematic review L. Robinson 1 * , D. Hutchings 1 , H. O. Dickinson 1 , L. Corner 1 , F. Beyer 1 , T. Finch 1 , J. Hughes 2 , A. Vanoli 1 , C. Ballard 3 and J. Bond 1 1 Centre for Health Services Research, University of Newcastle, School of Population & Health Sciences, Newcastle upon Tyne, UK 2 North Tyneside General Hospital, Northumbria Healthcare Trust, North Shields, Tyne & Wear, UK 3 Wolfson Centre for Age Related Disorders, Wolfson Wing, Hodgkin Building, Guy’s Campus, London, UK SUMMARY Background Wandering occurs in 15–60% of people with dementia. Psychosocial interventions rather than pharmaco- logical methods are recommended, but evidence for their effectiveness is limited and there are ethical concerns associated with some non-pharmacological approaches, such as electronic tracking devices. Objective To determine the clinical and cost effectiveness and acceptability of non-pharmacological interventions to reduce wandering in dementia. Design A systematic review to evaluate effectiveness of the interventions and to assess acceptability and ethical issues associated with their use. The search and review strategy, data extraction and analysis followed recommended guidance. Papers of relevance to effectiveness, acceptability and ethical issues were sought. Results (i) Clinical effectiveness. Eleven studies, including eight randomised controlled trials, of a variety of interventions, met the inclusion criteria. There was no robust evidence to recommend any intervention, although there was some weak evidence for exercise. No relevant studies to determine cost effectiveness met the inclusion criteria. (ii) Acceptability/ethical issues. None of the acceptability papers reported directly the views of people with dementia. Exercise and music therapy were the most acceptable interventions and raised no ethical concerns. Tracking and tagging devices were acceptable to carers but generated considerable ethical debate. Physical restraints were considered unac- ceptable. Conclusions In order to reduce unsafe wandering high quality research is needed to determine the effectiveness of non- pharmacological interventions that are practically and ethically acceptable to users. It is important to establish the views of people with dementia on the acceptability of such interventions prior to evaluating their effectiveness through complex randomised controlled trials. Copyright # 2006 John Wiley & Sons, Ltd. key words — dementia; ethical issues; health care; mental health BACKGROUND Wandering represents one of a range of behavioural problems occurring in people with dementia (Hope and Fairburn, 1990; Ballard et al., 1991; Cohen- Mansfield et al., 1992a; Hope et al., 1994). The term incorporates a complex collection of behaviours which occur for different reasons (Hope et al., 1994). Wandering behaviour has been described according to geographical pattern (Martino-Saltzman et al., 1991), typology (Hope et al., 1994) and linked to neurocognitive deficits (Algase, 1999). A single definition has been attempted (Snyder et al., 1978; Stokes, 1986) but this is unsatisfactory and does not INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY Int J Geriatr Psychiatry 2007; 22: 9–22. Published online 10 November 2006 in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/gps.1643 *Correspondence to: L. Robinson, Clinical Senior Lecturer in Dementia and Ageing Research, Centre for Health Services Research, University of Newcastle, School of Population & Health Sciences, 21 Claremont Place, Newcastle upon Tyne NE2 4AA. E-mail: a.l.robinson@ncl.ac.uk Copyright # 2006 John Wiley & Sons, Ltd. Received 28 February 2005 Accepted 1 June 2006